Korean Journal of Occupational Therapy (대한작업치료학회지)

Korean Society of Occupational Therapy (대한작업치료학회)
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The Treatment of Swallowing Disorders in Stroke Patients: A Systematic Review

뇌졸중 환자의 연하재활치료에 대한 체계적 고찰

  • Song, Wonil (Dept. of Occupational Therapy, Samsung Medical Center) ;
  • Jung, Min-Ye (*Dept. of Occupational Therapy, College of Healthy Science, Yonsei University)
  • 송원일 (삼성서울병원 재활의학과 작업치료실) ;
  • 정민예 (연세대학교 보건과학대학 작업치료학과)
  • Received : 2018.04.30
  • Accepted : 2018.05.28
  • Published : 2018.06.30
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Abstract

Objective: This study is a systematic analysis of swallowing rehabilitation treatment applied to stroke patients. The method of swallowing rehabilitation treatment according to the symptom of swallowing disorder and the effect of treatment was presented. The purpose of this study is to provide the data for selecting the effective treatment method according to the characteristics of the patients. Methods: A systematic review was conducted using the PRISMA checklist and flow charts. The database used PubMed, Medline Complete (EBSCOhost), and National Assembly Library of Korea. A total of 18 articles were used in the study and the PEDro scale (Physiotherapy Evidence Database scale) was used to evaluate the quality of the literature. In the literature, swallowing rehabilitation treatments were classified according to treatment effect and swallowing disorder symptoms. Results: In the analyzed study, 10 lesions were mixed with brain hemispheres and brainstem, 6 lesions were examined in cerebral cortex lesion, 1 brain lesion was examined, and 1 lesion was not recorded. There were 13 episodes of acute and chronic mixed episodes, 3 episodes of acute episodes of less than 3 months, and 1 episode of chronic episodes of 3 months or more. . Of the 14 treatments, 14 were effective on the irritation, and 1 was effective on the oral cavity and one on the diet. Methods of treatment were classified according to clinical symptoms of dysphagia. The most common treatment modalities were oral pharyngeal dysfunction and total 7 treatments. There are six different types of frontal and laryngeal movements of the hyoid and larynx, four types of aspiration and invasion, three delays in swallowing reflexes, weakness of the tongue, epiglottis residues, food pockets and temporal lag, Each treatment method was presented. Conclusion: This study may help occupational therapists to provide effective swallowing rehabilitation by applying various treatment modalities according to swallowing disorder symptoms of stroke patients.

목적 : 본 연구는 뇌졸중 환자에게 적용한 연하재활치료를 체계적으로 분석한 논문이다. 연하재활치료에 영향을 주는 요소들을 살펴보고, 연하장애 증상과 치료의 효과에 따른 연하재활치료 방법을 제시하였다. 이를 통하여 환자의 특성에 맞는 효과적인 치료 방법을 선택할 수 있도록 근거 자료를 제공하고자 한다. 연구방법: PRISMA(Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 체크리스트 및 흐름도를 이용하여 체계적 고찰을 시행하였다. 데이터베이스는 PubMed, Medline Complete(EBSCOhost), 국회 도서관(national assembly library of Korea)을 이용하였다. 연구에 사용된 문헌의 수는 총 18편이었고, 문헌의 질을 평가하기 위하여 PEDro scale(Physiotherapy Evidence Database scale)을 사용하였다. 문헌에서 사용한 연하재활치료들은 치료의 효과와 연하장애 증상에 따라 각각 분류하였다. 결과 : 분석된 논문에서 병변 부위는 대뇌반구와 뇌간 부위가 혼합된 연구 10편, 대뇌피질 부위 연구는 6편, 뇌간 부위 연구는 1편이었고, 병변 부위가 기록되지 않은 연구가 1편이었다. 발병 시기는 급성과 만성이 혼합된 연구 13편, 3개월 미만의 급성기 환자를 대상으로 한 연구 3편, 3개월 이상의 만성기 환자를 대상으로 한 연구 1편이었고, 발병 시기가 기록되지 않은 연구가 1편이었다. 총 14가지의 치료방법 중 인두기에 효과를 보인 치료가 14건, 구강기에 효과를 보인 치료와 식이 단계에 효과를 보인 치료가 각각 1건이었다. 연하장애의 임상 증상에 따라 치료방법을 분류하였다. 가장 많은 치료방법이 적용된 증상은 구강인두 기능저하로 총 7가지의 치료 방법이 제시되었다. 설골과 후두의 앞-위쪽 움직임 저하는 6가지, 흡인과 침습은 4가지, 삼킴반사 지연은 3가지, 혀의 근력 약화, 후두개 잔여물, 음식덩이의 인두통과시간 지연, 그리고 삼킬 때의 통증은 각각 1가지의 치료 방법이 제시되었다. 결론 : 본 연구는 작업치료사들이 뇌졸중 환자의 연하장애 증상에 따라 다양한 치료방법을 적용시킴으로써 효율적인 연하재활치료를 제공하는데 도움을 줄 수 있을 것이다.

Keywords

References

  1. 송영진, 우희순, 박은정, 윤인진, 오종치, 김은정, ... 홍재란. (2007). 삼킴장애. 서울, 한국: 계축문화사.
  2. Bulow, M., Speyer, R., Baijens, L., Woisard, V., & Ekberg, O. (2008). Neuromuscular Electrical Stimulation(NMES) in stroke patients with oral and pharyngeal dysfunction. Dysphagia, 23, 302-309. doi:10.1007/s00455-007-9145-9
  3. Carnaby-Mann, G. D., & Crary, M. A. (2007). Examining the evidence on neuromuscular electrical stimulation for swallowing: A meta-analysis. Archives of Otolaryngology-Head and Neck Surgery, 133, 564-571. doi:10.1001/archotol.133.6.564
  4. Foley, N. C., Teasell, R. W., Bhogal, S. K., & Speechley, M. R. (2003). Stroke rehabilitation evidence-based review: Methodology. Topics in Stroke Rehabilitation, 10(1), 1-7. doi:10.1310/Y6TG-1KQ9-LEDQ-64L8
  5. Fraser, C., Rothwell, J., Power, M., Hobson, A., Thompson, D., & Hamdy, S. (2003). Differential changes in human pharyngoesophageal motor excitability induced by swallowing, pharyngeal stimulation, and anesthesia. American Journal of Physiology Gastrointestinal and Liver Physiology, 285(1), G137-G144. doi:10.1152/ajpgi.00399.2002
  6. Hamdy, S., Jilani, S., Price, V., Parker, C., Hall, N., & Power, M. (2003). Modulation of human swallowing behaviour by thermal and chemical stimulation in health and after brain injury. Neurogastroenterology and Motility, 15(1), 69-77. doi:10.1046/j.1365-2982.2003.00390.x
  7. Hegland, K. W., Davenport, P. W., Brandimore, A. E., Singletary, F. F., & Troche, M. S. (2016). Rehabilitation of swallowing and cough functions following stroke: An expiratory muscle strength training trial. Archives of Physical Medicine and Rehabilitation, 97, 1345-1351. doi:10.1016/j.apmr.2016.03.027
  8. Heijnen, B. J., Speyer, R., Baijens, L. W. J., & Bogaardt, H. C. A. (2012). Neuromuscular electrical stimulation versus traditional therapy in patients with Parkinson's disease and oropharyngeal dysphagia: Effects on quality of life. Dysphagia, 27, 336-345. doi:10.1007/s00455-011-9371-z
  9. Hong, D. K., Kim, S. K., & Yoo, D. H. (2012). Effect of a shaker exercise on the swallowing function of stroke patients. Journal of Korean Society of Occupational Therapy, 20(3), 55-66.
  10. Huang, K. L., Liu, T. Y., Huang, Y. C., Leong, C. P., Lin, W. C., & Pong, Y. P. (2014). Functional outcome in acute stroke patients with oropharyngeal dysphagia after swallowing therapy. Journal of Stroke and Cerebrovascular Diseases, 23, 2547-2553. doi:10.1016/j.jstrokecerebrovasdis.2014.05.031
  11. Jung, J. S., & Park, J. H. (2015). The treatment of dysphagia in total thyroidectomy patients: A case study. Journal of Korean Society of Occupational Therapy, 23(2), 95-106. doi:10.14519/jksot.2015.23.2.08
  12. Jung, S. E. (2015). Effect of tongue-holding maneuver on the swallowing function in stroke patients(Master's thesis). Chosun University, Gwangju.
  13. Kim, H. D., Choi, J. B., Yoo, S. J., Chang, M. Y., Lee, S. W., & Park, J. S. (2017). Tongue-to-palate resistance training improves tongue strength and oropharyngeal swallowing function in subacute stroke survivors with dysphagia. Journal of Oral Rehabilitation, 44(1), 59-64. doi:10.1111/joor.12461
  14. Kim, S. Y., Choi, S. M., & Kim, Y. C. (1994). Rehabilitative management outcome of dysphagia. Annals of Rehabilitation Medicine, 18, 640-646.
  15. Koyama, Y., Sugimoto, A., Hamano, T., Kasahara, T., Toyokura, M., & Masakado, Y. (2017). Proposal for a modified jaw opening exercise for dysphagia: A randomized, controlled trial. Tokai Journal of Experimental and Clinical Medicine, 42(2), 71-78.
  16. Lim, K. B., Lee, H. J., Lim, S. S., & Choi, Y. I. (2009). Neuromuscular electrical and thermaltactile stimulation for dysphagia caused by stroke: A randomized controlled trial. Journal of Rehabilitation Medicine, 41, 174-178. doi:10.2340/16501977-0317
  17. Maher, C. G. (2000). A systematic review of workplace interventions to prevent low back pain. Australian Journal of Physiotherapy, 46, 259-269. doi:10.1016/S0004-9514(14)60287-7
  18. Maher, C. G., Sherrington, C., Herbert, R. D., Moseley, A. M., & Elkins, M. (2003). Reliability of the PEDro scale for rating quality of randomized controlled trials. Physical Therapy, 83, 713-721. doi:10.1093/ptj/83.8.713
  19. McCullough, G. H., Kamarunas, E., Mann, G. C., Schmidley, J. W., Robbins, J. A., & Crary, M. A. (2012). Effects of Mendelsohn maneuver on measures of swallowing duration post stroke. Topics in Stroke Rehabilitation, 19, 234-243. doi:10.1310/tsr1903-234
  20. Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Medicine, 6, e1000097. doi:10.1371/journal.pmed.1000097
  21. Nakamura, T., & Fujishima, I. (2013). Usefulness of ice massage in triggering the swallow reflex. Journal of Stroke and Cerebrovascular Diseases, 22, 378-382. doi:10.1016/j.jstrokecerebrovasdis.2011.09.016
  22. Park, J. S., Oh, D. H., Chang, M. Y., & Kim, K. M. (2016). Effects of expiratory muscle strength training on oropharyngeal dysphagia in subacute stroke patients: A randomised controlled trial. Journal of Oral Rehabilitation, 43, 364-372. doi:10.1111/joor.12382
  23. Park, J. S., Oh, D. H., Hwang, N. K., & Lee, J. H. (2016). Effects of neuromuscular electrical stimulation combined with effortful swallowing on post-stroke oropharyngeal dysphagia: A randomised controlled trial. Journal of Oral Rehabilitation, 43, 426-434. doi:10.1111/joor.12390
  24. Park, J. W., Kim, Y., Oh, J. C., & Lee, H. J. (2012). Effortful swallowing training combined with electrical stimulation in post-stroke dysphagia: A randomized controlled study. Dysphagia, 27, 521-527. doi:10.1007/s00455-012-9403-3
  25. Rofes, L., Arreola, V., Lopez, I., Martin, A., Sebastian, M., Ciurana, A., & Clave, P. (2013). Effect of surface sensory and motor electrical stimulation on chronic poststroke oropharyngeal dysfunction. Neurogastroenterology and Motility, 25, 888. doi:10.1111/nmo.12211
  26. Sun, S. F., Hsu, C. W., Lin, H. S., Sun, H. P., Chang, P. H., Hsieh, W. L., & Wang, J. L. (2013). Combined Neuromuscular Electrical Stimulation (NMES) with Fiberoptic Endoscopic Evaluation of Swallowing(FEES) and traditional swallowing rehabilitation in the treatment of stroke-related dysphagia. Dysphagia, 28, 557-566. doi:10.1007/s00455-013-9466-9
  27. Tooth, L., McCluskey, A., Hoffmann, T., Mckenna, K., & Lovarini, M. (2005). Appraising the quality of randomized controlled trials: Inter-rater reliability for the OTseeker evidence database. Journal of Evaluation in Clinical Practice, 11, 547-555. doi:10.1111/j.1365-2753.2005.00574.x
  28. Toyama, K., Matsumoto, S., Kurasawa, M., Setoguchi, H., Noma, T., Takenaka, K., ... Kawahira, K. (2014). Novel neuromuscular electrical stimulation system for treatment of dysphagia after brain injury. Neurologia Medico-Chirurgica, 54, 521-528. doi:10.2176/nmc.oa.2013-0341
  29. Xia, W., Zheng, C., Lei, Q., Tang, Z., Hua, Q., Zhang, Y., & Zhu, S. (2011). Treatment of post-stroke dysphagia by vitalstim therapy coupled with conventional swallowing training. Journal of Huazhong University of Science and Technology, 31(1), 73-76. doi:10.1007/s11596-011-0153-5
  30. Zhang, M., Tao, T., Zhang, Z. B., Zhu, X., Fan, W. G., Pu, L. J., ... Yue, S. W. (2016). Effectiveness of neuromuscular electrical stimulation on patients with dysphagia with medullary infarction. Archives of Physical Medicine and Rehabilitation, 97, 355-362. doi:10.1016/j.apmr.2015.10.104

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